Senator backs HIV test for surgeons State panel studies policy

Surgeons should be routinely screened for the virus that causes AIDS, says state Sen. Paula Hollinger, a nurse and a member of the Governor's Advisory Council on AIDS.

"We can't just look at the patient and say that the patient is the one to beware of," Hollinger, D-Balto. Co., said yesterday. "The provider of health care may also be in the same boat.

"We have a new issue now of the health provider being no different than the rest of us, also being capable -- even it it's just a small percentage of capability -- of passing this fatal disease on."

There is no simple answer to the issue of whether health-care workers should be screened for AIDS, she said, because the issue needs to be debated publicly from the medical, hospital and ethical viewpoints.

Hollinger said she is hoping the AIDS advisory council will consider this issue and add language to a bill it is working on that also will deal with policies that might apply when a physician or a nurse is carrying the human immunodeficiency virus (HIV).

The AIDS advisory council, headed by former U.S. Sen. Daniel B. Brewster, was created in 1987 by Gov. William Donald Schaefer to devise a statewide strategy to stop the spread of AIDS.

Hollinger also is chairman of the health subcommittee of the Senate Economic and Environmental Affairs Committee.

She made her comments while reacting to a legislative proposal by Johns Hopkins Hospital officials that would require surgeons and other physicians who are infected with the AIDS virus to tell hospital officials, who would then decide what the doctors should be allowed to do.

The recommendation is one of a series of actions taken by Hopkins in the wake of disclosures that Dr. Rudolph Almaraz, 41, a breast cancer surgeon at the hospital, died of acquired immune deficiency syndrome on Nov. 16. He did not tell his patients he had the disease.

Federal officials reportedly are "leaning strongly" toward a new AIDS policy that would recommend that surgeons and other health care workers routinely be tested and that anyone found to be infected with the virus would not be allowed to do surgery or other "invasive" procedures.

Under federal Centers for Disease Control guidelines, a surgical procedure is defined as one "in which a health care worker's hand is inside a body cavity where there is also a sharp instrument present." This would include most surgeries as well as many dental procedures.

A change in policy has been hotly debately on the federal level, the report said, since the CDC announcement last summer that a Florida dentist who died of AIDS may have infected one of his patients during a tooth extraction.

Curt Decker, an attorney and another member of the advisory council on AIDS, was highly critical of the Hopkins legislative proposal that would require surgeons and other doctors infected with the virus to report their illness to hospital officials.

"What would the penalties be if they don't and what if other people start turning them in?" he said. "That would create an incredible nightmare situation.

"We've spent all these last years and millions and millions of dollars telling the general public that this is not an easily transmitted disease and transmission is very low from patient to health care worker and even lower from health-care worker to patient.

"And, then, in the last three days, we've probably wiped out years of education for the general public and we've got everybody hysterical about going to a hospital and being infected by their health care professional."

He said Hopkins officials need to come before the advisory council "and tell us what the heck they are doing."

Hopkins is an internationally known hospital with the best of AIDS experts, Decker said, and yet, "They seem to be coming up with 'catch-as-catch-can' and 'react by crisis' responses to these AIDS issues.

"If they can't get it together, who can?" he asked.

Decker said he fears "we're headed toward mandatory testing of patients," which will reveal whether they are infected with the AIDS virus. If a patient is infected, surgeons might then refuse to do critically needed operations.

The AIDS advisory council has been hearing more and more from surgeons say they want to be able to screen patients. Doctors and surgeons in the Baltimore area "seem to be adamant" about finding out whether the person they are operating on has AIDS, he said.

"Once we start screening people, we're going to create a whole second class of individuals, people who are not going to have access to health care because we're going to know their antibody status [whether they have AIDS]," he said. "Is that what we want in this country?"

Decker said he believes there is a "whole movement afoot" for mandatory testing that starts with the health-care worker who is exposed, moves to the health-care workers who are infected and then to testing of all health-care workers and their patients.